This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The primary goal of this study is to investigate the effect of conventional versus early aggressive nutritional and respiratory intervention on survival, functional outcome and quality of life. Secondary objectives include the development and validation of strategies to improve tolerability of NIPPV (non-invasive positive pressure ventilation);evaluation of measurements of early respiratory dysfunction and determination of energy balance in ALS.